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1.
AIDS Care ; 34(2): 227-231, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-33625933

RESUMEN

HIV-associated functional impairment may cause cognitive impairment secondary to the viral infection, hence, associations between cognitive impairment and functional impairment in youth living with HIV are important to assess. We sought to determine whether cognitive impairment is associated with functional impairment and if it carries higher risk for also having functional impairment. We collected parent-rated information regarding youth functional impairment on four different measures and administered a cognitive battery to youth to determine cognitive impairment, 203 HIV-infected youth and 44 HIV-uninfected controls. Degree of cognitive impairment correlated strongly with decreased function: CBCL, r = -.17, p = .01; VABS2, r = -.28, p < .001; repeated-grades, r = .26, p < .001. Presence of cognitive impairment was associated with increased risk of functional impairment: 3.47 (CIS); 1.71 (CBCL); 2.17 (VABS2); 2.97 (repeated-grades). Repeated-grades strongly associated with cognitive impairment and functional impairment. We found strong associations between HIV-infected youth functional impairment on CBCL, VABS2 and repeated-grades with degree of cognitive impairment; and that when cognitive impairment was present youth had higher risk of experiencing functional impairment as well. Asking whether youth have repeated a grade at school could be a helpful screening question for assessing potential functional impairment and provide clinicians with an indication as to whether a further in-depth assessment is required.


Asunto(s)
Disfunción Cognitiva , Infecciones por VIH , Adolescente , Disfunción Cognitiva/complicaciones , Infecciones por VIH/psicología , Humanos , Tamizaje Masivo
2.
Health Aff (Millwood) ; 41(2): 195-202, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130060

RESUMEN

Few studies have illustrated how racism influences Black women's use of reproductive health care services. This article presents findings of a collaborative study conducted by a research team and a reproductive justice organization to understand Black women's concerns with sexual and reproductive health services. The qualitative research was conducted with Black women living in Georgia and North Carolina, using a community-based participatory research approach. Themes were developed from participant accounts that highlight how racism, both structural and individual, influenced their reproductive health care access, utilization, and experience. Structural racism affected participants' finances and led some to forgo care or face barriers to obtaining care. Individual racism resulted in some women electing to receive care only from same-race medical providers. These findings suggest a need for policies and practices that address structural barriers to reproductive health care access and improve the reproductive health experience of Black women.


Asunto(s)
Racismo , Servicios de Salud Reproductiva , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Salud Reproductiva , Conducta Sexual
3.
Health Aff (Millwood) ; 41(2): 256-264, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130065

RESUMEN

Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically reported worse care experiences than White enrollees. Few recent studies have identified disparities within and between Medicaid managed care plans. Using 2014-18 data on 242,274 nonelderly Medicaid managed care enrollees in thirty-seven states, we examined racial and ethnic disparities in four patient experience metrics. Compared with White enrollees, minority enrollees reported significantly worse care experiences. Overall adjusted disparities for Black enrollees ranged between 1.5 and 4.5 percentage points; 1.6-3.9 percentage points for Hispanic or Latino enrollees; and 9.0-17.4 percentage points for Asian American, Native Hawaiian, or other Pacific Islander enrollees. Disparities were largely attributable to worse experiences by race or ethnicity within the same plan. For all outcomes, disparities were smaller in plans with the highest percentages of Hispanic or Latino enrollees, and for some outcomes, there were smaller disparities in plans with the highest percentages of Asian American, Native Hawaiian, or other Pacific Islander enrollees. Interventions to mitigate racial and ethnic inequities in care experiences include collection of comprehensive race and ethnicity data, adoption of health equity performance metrics, plan-level enrollee engagement, and multisectoral initiatives to dismantle structural racism.


Asunto(s)
Medicaid , Disparidades en Atención de Salud , Humanos , Programas Controlados de Atención en Salud , Grupos Minoritarios , Evaluación del Resultado de la Atención al Paciente , Estados Unidos
4.
Health Aff (Millwood) ; 41(2): 237-246, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130071

RESUMEN

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.


Asunto(s)
Accesibilidad a los Servicios de Salud , Femenino , Geografía , Hospitales , Humanos , Embarazo , Estados Unidos
6.
PM R ; 14(1): 58-67, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-33611858

RESUMEN

BACKGROUND: FRAME, a mnemonic referring to a program for helping health care providers adapt patient-provider communication when working with patients with communication disorders, improves the knowledge, confidence, and communication skills of medical students for working with this population. However, the impact of the FRAME program for preparing students from the rehabilitation disciplines to work with patients with communication disorders is unknown. OBJECTIVE: To examine the effects of the FRAME program on the knowledge, confidence, and communication skills of students in physical therapy (PT), occupational therapy (OT), and prosthetics and orthotics (P&O) in terms of how to communicate effectively with patients with communication disorders. DESIGN: An exploratory, quasi-experimental pretest-posttest design. SETTING: PT, OT, and P&O clinical education programs at the University of Washington's Department of Rehabilitation Medicine. PARTICIPANTS: Twenty rehabilitation students (PT = 12; OT = 7; and P&O = 1) participated in the FRAME training. INTERVENTIONS: The FRAME program, delivered in a single, 2-hour session teaches students communication skills to use with patients with various types of communication disorders. MAIN OUTCOME MEASURES: A quiz of students' knowledge about communication disorders and a self-rating of confidence for interacting with this patient population were used. Speech-language pathology graduate clinicians rated students' use of communication strategies from each area of the FRAME training during interactions with standardized patients portraying aphasia and dysarthria. Student qualitative feedback were also collected. RESULTS: Students' knowledge, confidence, and use of communication strategies improved significantly following training. Greatest gains were observed in students' ability to familiarize themselves with how a patient communicates and establish a method of communication before proceeding with the interview. Qualitative feedback aligned with these findings. CONCLUSIONS: The FRAME program increases the knowledge, confidence, and use of communication strategies in rehabilitation students in order to communicate more effectively with patients with communication disorders in their future careers.


Asunto(s)
Trastornos de la Comunicación , Patología del Habla y Lenguaje , Estudiantes de Medicina , Competencia Clínica , Comunicación , Humanos , Patología del Habla y Lenguaje/educación , Estudiantes
7.
Rev. bras. med. esporte ; 28(3): 207-209, May-June 2022. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1365716

RESUMEN

ABSTRACT Introduction: One of the basic tasks of physical education in colleges and universities is to guide students to exercise and strengthen their physical fitness. Therefore, we need to study the physical function status of college students and the law of change in the learning process. Objective: To conduct physical training for college students and study the impact of exercise on physical function. Methods: Female college students are randomly divided into three groups with different training programs. The training cycle lasts 12 weeks. Results: There were statistical differences in the physical functions and qualities of the three groups of students after different training programs. Aerobic and strength training has obvious effects on improving students' skills. Conclusion: The combination of aerobic exercise and strength training enhances the physical function of female students. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: Uma das tarefas básicas da educação física em escolas e universidades é orientar os alunos para que façam exercícios e fortaleçam sua aptidão física. Portanto, precisamos estudar o status da função física de estudantes universitários e a lei da mudança no processo de aprendizado. Objetivo: Conduzir treinamentos físicos para alunos universitários e estudar o impacto da atividade na função física. Métodos: Universitárias (sexo feminino) foram aleatoriamente separadas em três grupos, com diferentes programas de treinamento. O ciclo de treinamento durou 12 semanas. Resultados: Houve diferenças estatísticas na função e qualidade físicas dos três grupos de estudantes depois de programas de treinamento diferentes. Treinos aeróbicos e de força tem efeitos evidentes na melhoria da habilidade das estudantes. Conclusão: O exercício aeróbico combinado com treino de força melhora a função física de estudantes do sexo feminino. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.


RESUMEN Introducción: Una de las tareas básicas de la educación física en escuelas y universidades es orientar a los alumnos para que hagan ejercicios y fortalezcan su aptitud física. Por lo tanto, necesitamos estudiar el status de la función física de estudiantes universitarios y la ley del cambio en el proceso de aprendizaje. Objetivo: Conducir entrenamientos físicos para alumnos universitarios y estudiar el impacto de la actividad en la función física. Métodos: Universitarias (sexo femenino) fueron aleatoriamente separadas en tres grupos, con diferentes programas de entrenamiento. El ciclo de entrenamiento duró 12 semanas. Resultados: Hubo diferencias estadísticas en la función y calidad físicas de los tres grupos de estudiantes después de programas de entrenamiento diferentes. Entrenamientos aeróbicos y de fuerza tienen efectos evidentes en la mejoría de la habilidad de las estudiantes. Conclusión: El ejercicio aeróbico combinado con entrenamiento de fuerza mejora la función física de estudiantes del sexo femenino. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

8.
Artículo en Español | BDNPAR, BDNPAR | ID: biblio-1369788

RESUMEN

Las revistas científicas son uno de los principales canales de difusión de los resultados de investigación y de institucionalización social de la ciencia en la mayoría de lasáreas del conocimiento.Sin embargo, es limitada la presencia de revistas latinoamericanas en las bases de datos como Web of Science (WOS) o Scopus con mucho prestigio en el mundo científico(1). Se han desarrollado proyectos regionales importantes con miras a aumentar la visibilidad y acceso a la productividad científica iberoamericana como Scientific Electronic Library Online ­SciELO(2)y la Red de Revistas Científicas de América Latina y el Caribe, España y Portugal ­RedALyC(3).El primero, desarrollado por FAPESP-BIREME Brasil hacia fines de la década de 1990 e implementado en más de diez países iberoamericanos, funciona como una biblioteca electrónica en línea que ofrece acceso abierto al texto completo de los artículos de unas 822 revistas(4).RedALyC, por su parte, es un proyecto más reciente,impulsado por la Universidad Autónoma del Estado deMéxico (UAEM), que bajo el lema "La ciencia que no se ve no existe" ofrece acceso al texto completo de artículos de758 revistas de 13 países de ALyC, España y Portugal(1).Son 19 revistas paraguayas las que están indexadas en SciELO(5)y ninguna en RedALyC(6). Tampoco ninguna revista paraguaya tiene presencia en SCOPUS,probablemente porque los requisitos son más exigentes(7). Sin duda,esto dificulta la difusión de la producción científica paraguaya en el contexto regional e internacional.El reconocimiento de las revistas depende en gran medida de su calidad ysu visibilidad.La calidad se define principalmente por el cumplimiento de un conjunto de pautas editoriales,de presentación, de gestión y de contenidos que garanticen el rigor científico de los artículos publicados en ellas(8). Su visibilidad se estima, tanto por el alcance dela difusión de las revistas como por el uso que la comunidad científica brinda a los artículos publicados en ellas, a través de la citación.Cuanta más visibles una revista,recibirá mayor oferta de trabajos y la publicación de los artículos así seleccionados,eleva la calidad de su contenido(9).Las revistas científicas paraguayas presentan muchas y muy variadas debilidades principalmente por falta de inversión en las mismas.La revista científica ciencias de la salud de la Universidad del Pacífico desde este número pasa a formar parte de la colección de revistas de SciELO. La editorial de la revista está realizando todos los esfuerzos para lograr su indexación en las bases de datos de mayor prestigio, sin embargo,aún hay un largo camino por recorrer.La incipiente sociedad científica paraguaya se caracteriza por no reconocer que el producto final de una investigación científica es una publicación científica(10). A pesar de que la productividad científica de los investigadores paraguayos ha aumentado en los últimos años, Paraguay sigue siendo uno de los países con menor productividad científica.En 2017, Paraguay ocupaba el puesto 133 en la producción mundial de artículos. Su índice h era de 76, lo que significa que tuvo 76 artículos ­con al menos un autor residente en Paraguay ­que alcanzaron 76 citas cada uno(11).Los programas impulsados por el CONACYT como el PRONII implementado desde el año 2011 ha logrado estimular la producción científica nacional y su visibilidad.Uno de los criterios para categorizar como investigador en el PRONII es precisamente la publicación de artículos en revistas indexadas en Latindex, Scielo, PubMed, Web of science o Scopus. En el año 2011 se habían publicado 238 artículos en revistas arbitradas, alcanzando el mayor número en el año 2012 con 340 publicaciones, que no ha bajadode este número hasta el año 2020.En nuestro país al año 2020 se cuenta con 514 investigadores categorizados en el PRONII12. La inversión en Investigación y Desarrollo Experimental (I+D)registrada en el periodo 2020 en lo que respecta al volumen de inversión total en I+D en guaraníes aumentó un 16% con respecto al año anterior(13).Se han desarrollado algunos estudios para evaluar la productividad científica de investigadores afiliados con alguna institución paraguaya(14), y de las revistas nacionales(15).En ninguno se ha utilizado el índice h para la evaluación de la productividad científica de investigadores paraguayos. Gómez y Samudio han desarrollado un estudio para valorar el desempeño de los investigadores paraguayos categorizados o no en el PRONII del área de salud a través del índice h, en el que se muestra una necesidad de mejorar la productividad y visibilidad medido por este índice;un muy reducido número de investigadores cumple con ser exitosos, con un índice mayor a 20(16).Existe necesidad de mayor inversión en las revistas científicas nacionales de manera a elevar su calidad para así ser parte de la colección de revistas de mayor impacto y de esa manera mejorar su visibilidad internacional y constituirse en una opción para los investigadores paraguayos.Además,recurrir a vínculos colaborativos con investigadores de instituciones con mayor productividad científica y así lograr mejor posicionamiento de los investigadores paraguayos a nivel internacional.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Investigadores , Publicación Periódica , Publicaciones Periódicas como Asunto
9.
BMC Public Health ; 22(1): 880, 2022 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505307

RESUMEN

BACKGROUND: About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. METHODS: We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O'Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. RESULTS: A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants' effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. CONCLUSIONS: People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.


Asunto(s)
Diversidad Cultural , Atención de Salud Universal , Australia , Servicios de Salud , Accesibilidad a los Servicios de Salud , Humanos
10.
J Healthc Eng ; 2022: 1112598, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35529544

RESUMEN

Currently, several methods are being applied to assess auditory temporal resolution in a controlled clinical environment via the measurements of gap detection thresholds (GDTs). However, these methods face two issues: the relatively long time required to perform the gap detection test in such settings and the potential of inaccessibility to such facilities. This article proposes a fast, affordable, and reliable application-based method for the determination of GDT either inside or outside the soundproof booth. The proposed test and the acoustic stimuli were both developed using the MATLAB® programming platform. GDT is determined when the subject is able to distinguish the shortest silent gap inserted randomly in one of two segments of white noise. GDTs were obtained from 42 normal-hearing subjects inside and outside the soundproof booth. The results of this study indicated that average GDTs measured inside the booth (5.12 ± 1.02 ms) and outside (4.78 ± 1.16 ms) were not significantly different. The measured GDTs were also comparable to that reported in the literature. In addition, the GDT screening time of the proposed method was approximately 5 minutes, a screening time that is much less than that reported by the literature. Data show that the proposed application was fast and reliable to screen GDT compared to the standard method currently used in clinical settings.


Asunto(s)
Audición , Ruido , Estimulación Acústica/métodos , Humanos , Programas Informáticos
11.
BMC Emerg Med ; 22(1): 75, 2022 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-35524171

RESUMEN

BACKGROUND: We conducted a systematic review of studies published in peer-reviewed journals on HIV screening programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of describing the methods, testing yields and challenges in these programs. METHODS: We searched for full-text, English-language, original research articles focused on the conduct, development, initiation or implementation of any HIV screening program in a US PED through eight online databases (Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals, 24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator independently and verified by a second investigator. Each program was summarized and critiqued. RESULTS: Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program, except for one that was focused on quality improvement of their program. Five described an opt-in and three an opt-out approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to 86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for testing in a healthcare setting. CONCLUSIONS: The studies illustrate opportunities to further optimize the integration of HIV screening programs within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs to identify cases. Future research should focus on advancing the methodology of screening programs beyond feasibility studies as well as conducting investigations on their implementation and longer-term sustainability.


Asunto(s)
Seropositividad para VIH , Adolescente , Niño , Servicio de Urgencia en Hospital , Prueba de VIH , Humanos , Tamizaje Masivo/métodos , Mejoramiento de la Calidad , Estados Unidos
12.
Inquiry ; 59: 469580221100777, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35538400

RESUMEN

Aim: To present nurses' experience in the decision-making process for implementing a therapeutic support limitation plan in the PICU. Method: Qualitative exploratory research was conducted through semi-structured interviews with 25 intensive care nurses from January to June 2019. The textual corpus was then submitted for content analysis. Results: Two categories emerged: the nurse and decision-making process of the TSLP and ambivalence of the participating nurse's feelings in implementing the TSLP. These categories are interrelated in that the decision-making process mobilizes the ambivalence of the participating nurses' feelings. Final considerations and implications for practice: The starting point of communication between the health teams consists of acquiring information about the concerned child's end-of-life care plan with no prospect of cure and with some form of therapeutic limit admitted to the PICU. Therefore, this study helps to map possible research gaps on the topic and mobilize researchers to build educational materials, protocols, and tools for comprehensive care that can be used by nurses when faced with ethical dilemma, such as decision-making through TSLP.


Asunto(s)
Enfermeras y Enfermeros , Cuidado Terminal , Niño , Comunicación , Toma de Decisiones , Humanos , Investigación Cualitativa
13.
BMJ Open ; 12(5): e053204, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501093

RESUMEN

INTRODUCTION: Chronic liver disease is a growing cause of morbidity and mortality in the UK. Acute presentation with advanced disease is common and prioritisation of resources to those at highest risk at earlier disease stages is essential to improving patient outcomes. Existing prognostic tools are of limited accuracy and to date no imaging-based tools are used in clinical practice, despite multiple anatomical imaging features that worsen with disease severity.In this paper, we outline our scoping review protocol that aims to provide an overview of existing prognostic factors and models that link anatomical imaging features with clinical endpoints in chronic liver disease. This will provide a summary of the number, type and methods used by existing imaging feature-based prognostic studies and indicate if there are sufficient studies to justify future systematic reviews. METHODS AND ANALYSIS: The protocol was developed in accordance with existing scoping review guidelines. Searches of MEDLINE and Embase will be conducted using titles, abstracts and Medical Subject Headings restricted to publications after 1980 to ensure imaging method relevance on OvidSP. Initial screening will be undertaken by two independent reviewers. Full-text data extraction will be undertaken by three pretrained reviewers who have participated in a group data extraction session to ensure reviewer consensus and reduce inter-rater variability. Where needed, data extraction queries will be resolved by reviewer team discussion. Reporting of results will be based on grouping of related factors and their cumulative frequencies. Prognostic anatomical imaging features and clinical endpoints will be reported using descriptive statistics to summarise the number of studies, study characteristics and the statistical methods used. ETHICS AND DISSEMINATION: Ethical approval is not required as this study is based on previously published work. Findings will be disseminated by peer-reviewed publication and/or conference presentations.


Asunto(s)
Hepatopatías , Proyectos de Investigación , Humanos , Hepatopatías/diagnóstico por imagen , Tamizaje Masivo , Literatura de Revisión como Asunto
14.
BMC Cancer ; 22(1): 522, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534802

RESUMEN

BACKGROUND: Cervical screening saves approximately 5000 lives annually in England. However, screening rates have been falling continuously, and coverage in London is particularly low (64.7%). While demographic predictors of uptake have been well researched, there has been less thorough investigation of the individual barriers and facilitators which predict cervical screening attendance. Understanding modifiable factors influencing attendance can guide the design of effective interventions to increase cervical screening uptake. The aim of this study was to understand the demographic, and individual factors associated with self-reported attendance at cervical screening in London. METHODS: The study used an online survey of 500 women in London (June-July 2017). The survey included self-reported measures of past attendance, demographic variables (including age, household income, ethnicity), past experience variables, and individual variables (list of potential barriers and facilitators developed based on the Theoretical Domains Framework and existing literature, which included: environmental context and resources, perceived risk, anticipated pain/embarrassment). Participants were categorised into regular attenders and non-regular attenders. Backwards stepwise logistic regression investigated the barriers and facilitators predicting past attendance. Demographic variables with significant differences between regular and non-regular attenders were added to the final regression model. RESULTS: Of women who had previously been invited (n = 461, age range: 25-65), 34.5% (n = 159) were classified as non-regular attenders, and 65.5% (n = 302) as regular attenders. The individual barriers and facilitators predicting attendance were: cervical screening priority, memory, environmental context and resources, and intention. The only demographic variables related to regular attendance were relationship status (married/civil partnership having higher rates than single) and higher household income. Relationship status was not significant when adjusting for barriers and facilitators. Those who have ever been sexually active or who have had an STI in the past were significantly more likely to be regular attenders. CONCLUSIONS: The study shows the importance of individual barriers and facilitators in predicting self-reported cervical screening attendance. Household income was the only significant demographic variable when combined with the individual variables. Interventions targeting priority, memory, and practical barriers affecting environmental context may be expected to be effective an increasing attendance.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias del Cuello Uterino , Adulto , Anciano , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control
15.
BMC Public Health ; 22(1): 920, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534821

RESUMEN

BACKGROUND: In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. METHODS: An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary. RESULTS: Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. CONCLUSION: Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.


Asunto(s)
Enfermedades Cardiovasculares , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Comunicación , Humanos , Investigación Cualitativa , Población Rural , Rwanda/epidemiología
16.
JMIR Mhealth Uhealth ; 10(5): e36404, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35536640

RESUMEN

BACKGROUND: Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES). OBJECTIVE: The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)? METHODS: A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3). RESULTS: After 12 weeks, 95.7% (178/186) of the participants stopped using the app. 30.1% (56/186) of the adolescents only opened the app on the installation day, and 44.1% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association. CONCLUSIONS: Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks. TRIAL REGISTRATION: ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858.


Asunto(s)
Promoción de la Salud , Telemedicina , Adolescente , Humanos , Clase Social , Encuestas y Cuestionarios
17.
J Med Internet Res ; 24(5): e37519, 2022 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-35588055

RESUMEN

BACKGROUND: Online false or misleading oral health-related content has been propagated on social media to deceive people against fluoride's economic and health benefits to prevent dental caries. OBJECTIVE: The aim of this study was to characterize the false or misleading fluoride-related content on Instagram. METHODS: A total of 3863 posts ranked by users' total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors' interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models. RESULTS: Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author's profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda. CONCLUSIONS: False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.


Asunto(s)
Caries Dental , Medios de Comunicación Sociales , Comunicación , Caries Dental/prevención & control , Fluoruros , Humanos
18.
BMJ Open ; 12(5): e058635, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35508345

RESUMEN

OBJECTIVES: The introduction of primary Human Papillomavirus (HPV) testing in the National Health Service (NHS) Cervical Screening Programme in England means the screening interval for 25-49 years can be extended from 3 to 5 years. We explored women's responses to the proposed interval extension. METHODS: We conducted semi-structured phone/video interviews with 22 women aged 25-49 years. Participants were selected to vary in age, socioeconomics and screening history. We explored attitudes to the current 3-year interval, then acceptability of a 5-year interval. Interviews were transcribed verbatim and analysed using framework analysis. RESULTS: Attitudes to the current 3-year interval varied; some wanted more frequent screening, believing cancer develops quickly. Some participants worried about the proposed change; others trusted it was evidence based. Frequent questions concerned the rationale and safety of longer intervals, speed of cancer development, the possibility of HPV being missed or cell changes occurring between screens. Many participants felt reassured when the interval change was explained alongside the move to HPV primary screening, of which most had previously been unaware. CONCLUSIONS: Communication of the interval change should be done in the context of broader information about HPV primary screening, emphasising that people who test negative for HPV are at lower risk of cell changes so can safely be screened every 5 years. The long time needed for HPV to develop into cervical cancer provides reassurance about safety, but it is important to be transparent that no screening test is perfect.


Asunto(s)
Alphapapillomavirus , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Detección Precoz del Cáncer , Inglaterra , Femenino , Humanos , Masculino , Tamizaje Masivo , Papillomaviridae , Infecciones por Papillomavirus/diagnóstico , Investigación Cualitativa , Medicina Estatal , Neoplasias del Cuello Uterino/prevención & control
19.
Inquiry ; 59: 469580221097424, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35491947

RESUMEN

Background and Objective: Despite that inherited (thalassemia and SCA) and infectious (hepatitis B, hepatitis C and AIDs) diseases and their risk factor consanguineous marriage are widespread among Yemen population, community-based awareness studies towards premarital screening (PMS) is extremely limited, so our study is designed to elicit knowledge and attitude of engaged and recently married couples in Taiz (Yemen) toward PMS. Methods: A cross-sectional study was conducted from April to September 2021 at Taiz. A well-structured questionnaire was designed and then delivered to participants to collect data. Results: The results revealed that majority of respondents (83.60%-94.18%) had knowledge about inherited and infectious diseases, respectively, and educational institution was the main knowledge source. Females had significantly higher knowledge than males (P ≤ .01), except about AIDs since no difference (P = .539). The results also revealed that majority of respondents had positive attitudes toward PMS, except toward AIDs testing since 70% of males and 68.91% of females had negative attitudes. The majority of respondents agreed that screening reduces the diseases incidence. Approximately half of respondents (50.79%-56.61%) tend to go ahead for marriage in case of positive results for inherited and infectious diseases respectively. Making PMS as an obligatory step prior engagement was agreed by 47.62% of respondents (45.71% of males, 48.74% of females). Conclusion: A high level of knowledge and positive attitudes toward inherited and infectious diseases and PMS were reported. This knowledge reflected on the agreement of majority of respondents regarding PMS importance in term of reduction of diseases incidence.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Tamizaje Masivo , Encuestas y Cuestionarios
20.
Artículo en Inglés | MEDLINE | ID: mdl-35500937

RESUMEN

The COVID-19 pandemic highlights the implications of chronic underinvestment in health workforce development, particularly in resource-constrained health systems. Inadequate health workforce diversity, insufficient training and remuneration, and limited support and protection reduce health system capacity to equitably maintain health service delivery while meeting urgent health emergency demands. Applying the Health Worker Life Cycle Approach provides a useful conceptual framework that adapts a health labour market approach to outline key areas and recommendations for health workforce investment-building, managing and optimising-to systematically meet the needs of health workers and the systems they support. It also emphasises the importance of protecting the workforce as a cross-cutting investment, which is especially important in a health crisis like COVID-19. While the global pandemic has spurred intermittent health workforce investments required to immediately respond to COVID-19, applying this 'lifecycle approach' to guide policy implementation and financing interventions is critical to centering health workers as stewards of health systems, thus strengthening resilience to public health threats, sustainably responding to community needs and providing more equitable, patient-centred care.


Asunto(s)
COVID-19 , Fuerza Laboral en Salud , Programas de Gobierno , Personal de Salud , Humanos , Pandemias
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